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Possible Cancer - surgery
02-19-2018, 03:02 PM,
Possible Cancer - surgery
Hello All,
I just wanted to share what we are currently going through and see if anyone went through the same thing and if so what they did. Any advice etc.  
My 11  year old Border Collie Lucy went in for a Ultra Sound to look for bladder stones because of recurrent infections.  The bladder was fine so it is truly recurrent UTI's we are dealing with and this has happened to her in the past. Unfortunately during the ultra sound they came across a tiny 2.3 cm mass in her intestine with slight wall thickening and abnormal layering at the mass.   The Radiologist feels this is VERY early and a lucky find hopefully. She said everything else looked fine her lymph nodes looked good. They did also find 2 small masses in her liver but they feel it is most likely benign and is very common for older dogs to have these. 
The radiologist feels this mass in her intestine (small intestine) is most likely adenocarcinoma and if not then possibly Lymphoma or possibly another type of benign neoplasia.. but leans heavily toward cancer. 
We followed up with chest x-rays as they said that is the most important step before moving on and they were all clear. 
We talked with a specialist surgeon/doctor last week. This hospital is very nice and they also have a cancer department etc. They are one of the best in the area.  
The dr./surgeon both agree that it needs to come out.  Bottom line is even if it is benign it will grow and then we have an emergency situation of an obstruction and emergency surgery.   Which is even riskier.   They feel we need to do it now why she appears in good health with good blood work and everything going for her.   The surgery is scheduled in 2 weeks. They will do a Fine Needle Ultrasound right before they are ready to operate so she isn’t sedated 2 times. The cancer department will review the slide to make sure it is not Lymphoma.  Apparently they can see Lymphoma cells easy this way but really do not get a good diagnosis on anything else. The surgeon will not operate on Lymphoma. If that is what it is they do not proceed to the operating room and set up a treatment plan instead.  
I do not want her to have surgery she is my baby and I have protected her for 11 years and it scares me to think of the 10-15% complication rate.  The complication is that the intestines do not heal together in the first 5 days which then causes leakage and sepsis and they can go in with another surgery to try and repair but most people do not because it comes down to about a 1% chance of survival at that point.   They did tell me they do 100's of these surgeries and at least a couple a day and that percent is the textbook number that as long as she is healthy going in and not suffering obstruction and her Albumin level is good then that makes that number very small. Most of the dogs that have complications have a foreign object and are in bad shape and already have some sepsis and dying tissue and also a lot of the complication has to do with poor Albumin levels.   
I can deal with what they find. If it is cancer that spread we will deal with it and if it is Lymphoma we will do treatment but what is making me feel like I could be doing something wrong is taking her into this surgery as a healthy dog knowing there is a slim chance she will have the complication and then have to be put to sleep in a few days and I pretty much decided her fate. 
I would just love to hear if anyone else has gone through this surgery and if they had a complete recovery and what your thoughts are.  It is so hard knowing you are doing the right thing for you dog who has  been so loving and loyal and counts on you.
Thank you for taking the time to read this. 
02-19-2018, 07:35 PM,
RE: Possible Cancer - surgery
You are in a tough situation, and it's mostly because there is no idea on what you are dealing with exactly and definite diagnosis is only possible with removal and biopsy of the mass.

Whether it's completely worth it doing surgery is therefore a matter of whether there is just one mass and what is found: you may be dealing with lymphoma, adenocarcinoma or leiomyoma just to name a few. Many of these cancers are curative with surgery if there is no metastasis (cancer spread) yet.

On the other hand, if you don't do the surgery, you have to consider the risks associated with letting the tumor grow which can happen to such an extent that an emergency surgery will be needed and by then the tumor may have spread to the liver or lungs. Things as you imagine will be more challenging at this point.

It may feel like you are stuck between a rock and a hard place, but perhaps the best choice is ultimately looking at statistics. A risk of 10 to 15 percent is rather low compared to the risks of certain cancers. For instance consider that with adenocarcinoma and leiomyosarcoma, the rate of metastasis is quite high. Also, median survival times for small intestine adenocarcinoma is 12 days without treatment and 114 days with surgical intervention (source National Canine Foundation).

The surgery to remove the mass is similar to the surgery performed when a dog has ingested a foreign object and it gets stuck. However, it seems that in foreign object cases the risks are higher. Here's what statistics say "One study found a dehiscence (rupture of sutures) incidence of 16% of enterotomies and anastomoses in dogs with a mortality rate of 74%. Dogs with foreign bodies and trauma appeared to be at higher risk for dehiscence in this study. Clinical evidence of peritonitis (infection when there's a leak) appeared at about 3 days postoperatively."

Also: "In a study of dogs having intestinal surgery, high risk for dehiscence was found if a dog had 2 of the 3 following clinical factors: pre-existing peritonitis, foreign body, or a serum albumin of less than 2.5g/dl.3 "Your dog seems to have none of those. On top of that consider this "clinical experience tells us that dogs with metastatic intestinal neoplasia are also at higher risk for incisional breakdown." Since your dog's mass showed no signs of metastasis based on liver ultrasound and lung x-rays, this suggests the surgery is better done now than later.

There are many steps veterinary specialists will take to lower those risks for surgical complications. If you are not too squeamish about it, this is a great read about the many steps taken to prevent leaking problems. https://www.acvs.org/files/proceedings/2...rs/057.pdf

Some other studies with statistics:

Allen DA, Smeak DD, Schertel ER. Prevalence of small intestinal dehiscence and associated clinical factors: a retrospective study of 121 dogs. J Am Anim Hosp Assoc 1992;28:70-76.

C J Shales, J Warren, D M Anderson, S J Baines, R A S White. Complications following full-thickness small intestinal biopsy in 66 dogs: a retrospective study. Journal of Small Animal Practice 08/2005; 46(7):317-21.

Ralphs SC, Jessen CR, Lipowitz AJ. Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991-2000). J Am Vet Med Assoc 2003;223:73-77

I hope this helps. Maybe it may help consulting again with the surgeon just to go over things so that you will feel better about the situation and can ask more questions? Maybe seek a second opinion? Sometimes that can help. I can understand how you feel. Having owners senior dogs myself as well I know how it feels taking some risks when we have taken so much care of our dogs, but sometimes part of that care entails evaluating the odds between the number of favorable outcomes to the number of unfavorable outcomes.

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